Chn ppt 2011 part 1


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Chn ppt 2011 part 1

  2. 2. 12/05/12 2
  3. 3. Community Health Nursing: The 3 Broad Concepts1. What is a community? – a group of people with common characteristics or interests living together within a territory or geographical boundary – place where people under usual conditions are found – The community is the object or focus of care in CHN, with the family as the unit of service.12/05/12 3
  4. 4. FACTS of CHNFocus : promotion and preservation of healthArea of Content: skills and knowledge relevant to both nursing and public healthClients : general populations (individuals, families, communities)Time : continual, not limited to episodic careScope : comprehensive and general, not limited to a particular age or group12/05/12 4
  5. 5. Concepts on Community Health Nursing: CLIENTS of Community Health Nurse  Composed of different levels of clientele: Individual, family, population group, and community • Community as a SETTING for CHN PRACTICE  School Health Nursing- School  Occupational Health Nursing- Workplace  Public Health Nursing-Home12/05/12 5
  6. 6. 2. What Is Health? A state of complete physical, mental, and social well- being and not merely the absence of disease and infirmity (WHO, 1995).12/05/12 6
  7. 7. What is Health? •It carries the mandate that health is a basic human right. •It is seen as a spectrum or a continuum•The modern concept of health refers toOptimum Level of Functioning (OLOF) ofindividuals, families, and communities, which isinfluenced by the ecosystem through a myriadof factors.12/05/12 7
  8. 8. What influences OLOF?• Behavioral (culture, habits, mores, ethnic customs)• Socio-economic (employment, education, housing)• Political (safety, oppression, people, empowerment)• Hereditary (genetic endowment, familial, racial)• Health Care Delivery System (promotive, preventive, curative, rehabilitative)• Environment (air, food, water, wastes, noise, radiation, pollution, congestion)
  9. 9. 3. What is Nursing?  The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980).  Nursing, together with public health, is one of the helping professions in the health care system which operates at three levels of clientele – individuals, families or groups, and communities12/05/12 9
  10. 10. It operates within the realm of health care both independently and interdependently.The objective of nursing is to assist clients to achieve, maintain, or recover a high level of functioning.Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness (Henderson)12/05/12 10
  11. 11. The PHILOSOPHY of CHN • is based on the worth and dignity of man (Shetland)
  12. 12. •Concepts andPrinciples pertaining to CHN
  13. 13. Knowledge-base of CHN • Biological and social sciences • Ecology • Clinical Nursing12/05/12 13
  15. 15. • it is population-focused – “the greatest good for the greatest number” > Community diagnosis > Vital statistics > Priority setting• it is a promotive-preventive service – adheres to Primary Health Care > Health education > Preventive treatment• It is a generalist practice – deals with all12/05/12 cases 15
  16. 16. The ULTIMATE GOAL of CHN • By: RAISE the  help communities and families cope with discontinuities in health andlevel of health threats  Maximize their potential for of high level wellness  Promote reciprocally supportive relationship citizenry… between people and their physical and social12/05/12 environment 16
  17. 17. The PRIMARY FOCUS of CHNhealth promotion wherein health teaching is the primaryresponsibility of the communityhealth nurse, who is a generalist in terms of practice12/05/12 17
  18. 18. Principles of CHNE – ducation as primary tool and responsibilityM – ade available to all regardless of race, creed and socio-economic statusP – olicies and objectives of the agency is fully understood by the nurseO – rganizing for health, with the family as the unit of serviceW – orks as a member of the health team (PHN)E – xisting active organizations are utilizedR – ecording and reporting are accurateM – onitoring and evaluation of services is periodically doneE – xisting indigenous resources of the community is usedN – eeds of clienteles is recognized and serves as basis for CHNT – raining and development as opportunities for continuing staff education programs12/05/12 18
  19. 19. REMEMBER that in CHN:1. The patient in CHN is the Community which is composed of different population groups and several families (the basic unit of care), and In turn compose of individuals.2. Client is ACTIVE and NOT PASSIVE recipient of care3. CHN practice is affected by any changes in society and environment4. Multi-sectoral effort is the key to goal achievement5. CHN is a part of health care system and the larger human services system.12/05/12 19
  20. 20. Quick Review Exercises (QRX)12/05/12 20
  21. 21. QRXIn terms of CHN practice, the nurse in the community is trained asa. Certified in public healthb. Specialist in CHNc. 4-year BSN graduated. Generalist in nursing12/05/12 21
  22. 22. Ans: d. Generalist in nursing
  23. 23. QRX The thrusts of CHN must be embodied in the hearts of health care providers. Which one strengthens the health care system? a. Supporting conditions for healthy habits b. Increasing opportunities to be healthy c. Letting the people manage their own health d. Financing health care programAns: c.Letting the people manage their own health 12/05/12 23
  24. 24. Ans: c.Letting the people manage their own health
  25. 25. QRXAs a Public Health Nurse, what is your primary function or responsibility?a. Reporting of casesb. Health Promotionc. Community Diagnosisd. Health Teaching12/05/12 25
  26. 26. • Ans: d. Health Teaching
  27. 27. QRXThe philosophy of CHN practice is based on the belief that the family is the smallest unit in a democratic society. Which age group should be the priority of the nurses in the community?a. Older persons and terminally illb. Adolescents and adultsc. Infants and childrend. All ages regardless of status12/05/12 27
  28. 28. Ans: d. All ages regardless of status
  29. 29. HIGHLIGHTS in CHN Concepts •CHN is based on the recognized needs of communities, families, groups, ands individuals. •CHN is a unique blend of nursing and public health practice, and is oftentimes used interchangeably with the term “Public Health Nursing”.12/05/12 29
  30. 30. Philosophy of Public Health Health and longevity as birthrights Longevity – average lifespan or life expectancy• 50 years – Swaroop’s Index• Untimely death – person died without reaching the average lifespan Combined (M/F) – 69.6 y/o Male – 66.74 y/o Female – 72.61 y/o12/05/12 30
  31. 31. Objectives of Public Health 3 P’s: Promote health Prevent Disease Prolong Life12/05/12 31
  32. 32. Basic Public Health Services• Environmental Sanitation• Health Education• Prevention of Communicable Diseases• Medical Services• Nursing Services• Vital Statistics• Public Health Laboratories• Maternal and Child Health Services12/05/12 32
  33. 33. Basic Competencies Needed by the Public Health Nurse• Teaching• Management• Critical Thinking• Physical Caregiving• Application of the Nursing Process• Application of the Epidemiological Process• Documentation12/05/12 33
  34. 34. Functions of the PHNManager > Planner, Programmer, Supervisor, Coordinator of servicesHealth Care Provider > Direct nursing careResearcher > Epidemiologist, Health Monitor, Recorder, StatisticianCommunity Organizer > Change AgentTrainer > Health Educator, CounselorRole Model12/05/12 34
  35. 35. In the care of the families:Provision of primary health care services Developmental/Utilization of family nursing care plan in the provision of care12/05/12 35
  36. 36. In the care of the communities:• Community organizing mobilization, community development and people empowerment• Case finding and epidemiological investigation• Program planning, implementation and evaluation• Influencing executive and legislative individuals or bodies concerning health and development12/05/12 36
  37. 37. Responsibilities of CHN: – be a part in developing an overall health plan, its implementation and evaluation for communities – provide quality nursing services to the three levels of clientele, the standards ser for CHN practice – maintain coordination/linkages with other health team members, NGO/government agencies in the provision of public health services – conduct researches relevant to CHN services to improve provision of health care – provide opportunities for professional growth and continuing education for personal growth thru staff development12/05/12 37
  38. 38. CHN Process1. Establishing a working relationship with the client • Initiating contact • Communicating interest in the client’s welfare • Showing willingness to help with expressed need of the client • Maintaining a two-way communication with the client12/05/12 38
  39. 39. CHN Process2. Assessment of needs, taking into consideration personal, environmental and psycho-socio- cultural factors influencing health • Situation and trends revealed in personal, socio- economic and environmental history • Physical, emotional, intellectual ability to perform a function • Attitudes, knowledge and perceptions of health and illness • Health behavior and patterns of health care • Resources available to meet own needs • Other factors affecting health12/05/12 39
  40. 40. A. Collection of Data A. Community  Demographic data  Vital statistics  Community Dynamics  Disease surveillance  Economic, cultural , and environmental characteristics  Health service utilization B. Family and Individual - Health status/ education - Socio-cultural factors - Occupation - Family dynamics - Environment - Patterns of coping12/05/12 40
  41. 41. B. Categories of Health Problem A. Wellness State B. Health Deficit C. Health Threat D. Foreseeable Crisis12/05/12 41
  42. 42. CHN Process3. Planning of care• Summarizing problems and needs• Establishing priorities of care• Setting objectives of care• Determining approaches or strategies to meet identified objectives12/05/12 42
  43. 43. CHN Process4. Implementation of care• Actual delivery of care• Institution of planned interventions• Application of coordination, supervision, social mobilization, health education, therapeutic communication12/05/12 43
  44. 44. CHN Process 5. Evaluation of care • Monitoring of status • Systematic documentation of results • Analysis of effectiveness of care provided (Structural elements, Process Elements, and Outcome elements)12/05/12 44
  45. 45. Levels of Clientele Individual• Basic approaches in looking at the individual: – Atomistic – Holistic12/05/12 45
  46. 46. FamilyModels:DevelopmentalStages of Family DevelopmentStage 1 – The Beginning FamilyStage 2 – The Early Child-bearing FamilyStage 3 – The Family with Preschool Children 12/05/12 46
  47. 47. Stage 4 – The Family with School Age ChildrenStage 5 – The Family with Teen-agersStage 6 – The Family as Launching CenterStage 7 – The Middle-aged FamilyStage 8 – The Aging Family12/05/12 47
  48. 48. Structural-Functional Initial Data Base Family structure and Characteristics Socio-economic and Cultural Factors Environmental Factors Health Assessment of Each Member Value Placed on Prevention of Disease12/05/12 48
  49. 49. First Level AssessmentHealth threats: conditions that are conducive to disease, accident or failure to realize one’s health potentialHealth deficits: instances of failure in health maintenance (disease, disability, developmental lag)Stress points/ Foreseeable crisis situation: anticipated periods of unusual demand on the individual or family in terms of adjustment or family resourcesWellness State/ Potential12/05/12 49
  50. 50. Second Level Assessment:• Recognition of the problem• Decision on appropriate health action• Care to affected family member• Provision of healthy home environment• Utilization of community resources for health care12/05/12 50
  51. 51. Problem Prioritization: Nature of the problem Wellness State Health deficit Health threat Foreseeable Crisis Preventive potential High Moderate Low12/05/12 51
  52. 52. • Modifiability Easily modifiable Partially modifiable Not modifiable• Salience High Moderate Low12/05/12 52*Family Service and Progress Record
  53. 53. Population Group• Vulnerable Groups:Infants and Young Children School age Adolescents Mothers Males Old People12/05/12 53
  54. 54. CHN ProcessCommunity Diagnosis• Determining the health status of thepopulations in the community as well as thefactors that directly or indirectly affect theirhealth status• It is an integral part of the assessment phase of the CHN Process• It is also known as community assessmentor situational analysis 12/05/12 54
  55. 55. • A process by which the people in the community and the health team assess the community’s health problems and needs as bases for health program development.• A learning process for the community to identify their own health problems and needs.• A profile that depicts the health problems and potentials of the community.12/05/12 55
  56. 56. 2 types of Community Diagnosis:1.Comprehensive- provides general health profile of the community2.Specific or Problem-Oriented- yields a comprehensive profile of a particular health problem12/05/12 56
  57. 57. STEPS:Preparatory Phase 1. site selection 2. preparation of the community 3. statement of the objectives 4. determine the data to be collected 5. identify methods and instruments for data collection 6. finalize sampling design and methods 7. make a timetable12/05/12 57
  58. 58. Implementation Phase 1. data collection 2. data organization/collation 3. data presentation 4. data analysis 5. identification of health problems 6. prioritization of health problems 7. development of a health plan 8. validation and feedbackEvaluation Phase12/05/12 58
  59. 59. CHN ProcessParts of Community Diagnosis:A. Demographic Variables • Total population and population density • Age and sex composition, Population Pyramid • Sex Ratio • Civil Status • Population movement/patterns of migration • Growth Rate, Life Expectancy12/05/12 • Crude Birth Rate, Crude Death Rate 59
  60. 60. CHN ProcessParts of Community Diagnosis:B. Social Indicators • Literacy Rate • Educational attainment • Communication network • Transportation system • Housing conditions (types, ownership, lighting, ventilation, crowding/congestion) 12/05/12 60
  61. 61. CHN ProcessParts of Community Diagnosis:C. Economic Indicators • Dependency Ratio • Occupation • Income • Poverty index • Unemployment Rate • Underemployment Rate • Types of industry present in the community 12/05/12 61
  62. 62. CHN ProcessParts of Community Diagnosis:D. Cultural Factors • Ethnicity • Race • Language • Religion • Beliefs (superstitions and traditions)12/05/12 62
  63. 63. CHN ProcessParts of Community Diagnosis:E. Environmental Indicators • Topographical characteristics • Water supply • Garbage disposal/collection system • Excreta disposal • General sanitary condition12/05/12 63
  64. 64. CHN ProcessParts of Community Diagnosis:F. Health Patterns • Food storage • Infant feeding practice • Immunization status • Health seeking behavior • Source of health information • Leading causes of mortality, morbidity, infant mortality, infant morbidity, maternal mortality12/05/12 64
  65. 65. CHN ProcessParts of Community Diagnosis:G. Health Resources • manpower-population ratio • manpower distribution • manpower policies • health budget and policies • sources of health funding • categories of health institutions available12/05/12 • categories of health services available 65
  66. 66. CHN ProcessParts of Community Diagnosis:H. Political and Leadership Patterns • Power structures in the community • Confidence of people to authority • Conditions that cause developmental conflicts • Prevailing issues • Practices that are usually utilized in settling concerns of the community • Stakeholder Analysis12/05/12 66
  67. 67. CHN ProcessSteps in Conducting Community Diagnosis:1. Determining the objectives2. Defining the study population3. Determining the data to be collected4. Developing an instrument • survey questionnaire • interview schedule 12/05/12 67
  68. 68. CHN ProcessSteps in Conducting Community Diagnosis:5. Data gathering • Records review • Observation • Surveys • Interviews6. Data collation 12/05/12 68
  69. 69. CHN ProcessSteps in Conducting Community Diagnosis:7. Data presentation8. Data analysis9. Identification of CHN Problems • Health status • Health resources • Health-related12/05/12 69
  70. 70. CHN ProcessSteps in Conducting Community Diagnosis:10. Prioritization of CHN Problems • Nature • Magnitude • Modifiability • Preventive potential12/05/12 • Social concern 70
  71. 71. BiostatisticsA. Demography A study of population size, composition, and spatial distribution as affected by births, deaths, and migration12/05/12 71
  72. 72. SOURCES OF DEMOGRAPHIC DATA:1.Survey 1. Census- De jure or De facto 2. Sample Survey2.Continuing Population Registers3.Other Records and Registration Systems12/05/12 72
  73. 73. COMPONENTS:Population Size 1. Natural increase 2. Net migration 3. Rate of natural increasePopulation Composition 1. Age Distribution 2. Median Age 3. Dependency Ratio 4. Sex Ratio 5. Population Pyramid 6. Others: occupational groups, economic groups, educational attainment, and ethnic groups12/05/12 73
  74. 74. Population Distribution 1. Urban-Rural • Shows the proportion of people living in urban compared to the rural areas 1. Crowding Index • Indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host 1. Population Density • Determines the congestion of the place12/05/12 74
  75. 75. B. VITAL STATISTICS The application of statistical measures to vital events (births, deaths and common illnesses) that is utilized to gauge the levels of health, illness and health services of a community.• Fertility Rate – Crude Birth Rate –12/05/12 General Fertility Rate 75
  76. 76. Mortality Rates Crude Death Rate Specific Mortality Rate Infant Mortality Rate Neonatal Mortality Rate Post-neonatal Mortality Rate Maternal Mortality Rate Proportionate Mortality Rate Swaroop’s Index Case Fatality Rate Cause-of- Death RateMorbidity Rate Prevalence Incidence Rate12/05/12 76
  77. 77. C. EPIDEMIOLOGY – The study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution – The study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations12/05/12 77
  78. 78. Basic Concepts: – Epidemiologic Triad – Transmission – Incubation period – Herd immunity12/05/12 78
  79. 79. Factors affecting distribution:• PERSON – intrinsic characteristics• PLACE – extrinsic factors• TIME – temporal patterns12/05/12 79
  80. 80. Patterns of Disease Occurrence:• Epidemic – a situation when there is a high incidence of new cases of a specific disease in excess of the expected. – when the proportion of the susceptible are high compared to the proportion of the immunes• Epidemic potential – an area becomes vulnerable to a disease upsurge due to causal factors such as climatic changes, ecologic changes, or socio- economic changes12/05/12 80
  81. 81. • Endemic – habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptible e.g. Malaria is a disease endemic at Palawan. – the causative factor of the disease is constantly available or present to the area.• Sporadic – disease occurs every now and then affecting only a small number of people relative to the total population – intermittent• Pandemic – global occurrence of a disease12/05/12 81
  82. 82. THE NATIONAL HEALTH SITUATION Health Care Delivery SystemHealth Care Delivery System is “the totality of all policies, facilities, equipments, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.”12/05/12 82
  83. 83. According to Increasing According to the Type Complexity of the Services of Service Provided Type Service Type ExamplePrimary Health Promotion, Health Information Preventive Care, Continuing Promotion Disseminati Care for common health and illness on problems, attention to Prevention psychological and social care, referralsSecondary Surgery, Medical services by Diagnosis and Screening Specialists TreatmentTertiary Advanced, specialized, Rehabilitation PT/OT diagnostic, therapeutic & rehabilitative care12/05/12 83
  84. 84. TheHealthSector 12/05/12 84
  85. 85. The Health SectorDepartment of Health Vision: Leader and staunch advocate and model in promoting Health for ALL in the Philippines Mission: Guarantee equitable, sustainable, and quality health for all Filipinos, specially the poor and shall lead the quest for excellence in health 12/05/12 85
  86. 86. 3 Major Functions:1. LEADERSHIP in health National policy – formulation, monitoring and evaluation Regulatory institution Advocates adoption of health policies, plans and programs2. Enabler and Capacity Builder Innovate new strategies to improve health programs Exercise oversight function Ensure highest achievable standards3. Administrator of Specific Services Manage selected national health facilities and hospitals Administer direct services for emergent health concerns Administer health emergency response services12/05/12 86
  87. 87. DOH ProgramsD – ental HealthO – perations for Environmental SanitationH – ealth Education and Community OrganizingP – revention and Control of Communicable DiseasesR – eproductive HealthO – lder Persons Health ServicesG – uidelines for NutritionR – ehabilitation and Management of Non-communicable Dse.A – lternative Health Care Practices (HerbalMeds/Acupressure)M – aternal and Child Health and IMCIS – entrong Sigla Movement12/05/12 87
  88. 88. Local Government Units (LGU) RA 7160 Local Government CodePrivate Sector Composed of both commercial and business organizations, non-business organizationsNon-Government Organizations Assumes the following roles:  Policy and Legislative Advocates  Organizers, Human Rights Advocates  Research and Documentation  Health Resource Development Personnel  Relief and Disaster Management  Networking12/05/12 88
  89. 89. PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL Health Promotion and Prevention of Prevention of Illness Prevention Complications thru Disability, etc. Early Dx and TxProvided at – ► When hospitalization ► When highly-► Health care/RHU is deemed specialized medical care► Brgy. Health Stations necessary and referral is is necessary►Main Health Center made to emergency ► Referrals are made to►Community Hospital (now district), provincial hospitals and medicaland Health Center or regional or private center such as PGH,►Private and Semi- hospitals PHC, POC, Nationalprivate agencies Center for Mental Health, and other gov’t private hospitals at the municipal level12/05/12 89
  90. 90. Primary Health CareWHO: PHC was declared in the ALMA ATA CONFERENCE(USSR) in September 6- 12, 1978, as a strategy to community health development.Philippines: Adopted through LOI 949 signed by President Marcos on October 19, 1979 with the theme- “Health in The Hands of the People by 2020”12/05/12 90
  91. 91. Primary Health Care12/05/12 91
  92. 92. Framework12/05/12 92
  93. 93. How can PHC be possible?Control of Communicable DiseasesOffers Health EducationMaternal and Child CareProvision of Medical Care and Emergency TreatmentOffers “Immunization”Nutrition and Food SupplyEnvironmental SanitationN “Family Planning”Treatment of Locally Endemic DiseasesSupply and Proper Use of Essential Drugs12/05/12 93
  94. 94. S P S C U E R O P C O M P T P M. O O E R R R P T A A L T R M E T E L C I C I H P H N N A A K O T N A L I I G O O S E G N M S Y12/05/12 94
  95. 95. PILLARSA. Multi-sectoral approach Intersectoral linkages (population control, private sectors, social welfare, public service, enrironmental, etc.) Intrasectoral linkages (people’s empowerment; within own system)B. Community Participation e.g. Community Organizing12/05/12 95
  96. 96. C. Appropriate Technology - method used to provide a socially and environmentally acceptable level of service or quality product at the least economic cost .Criteria: Safe Acceptable Feasible Effective Scope-wise Affordable Complex12/05/12 96
  97. 97. 10 Medicinal Plants:Bawang-anti cholesterolUlasimang-Bato-lowers uric acidBayabas- antiseptic; diarrheaLagundi-cough, asthma, and coldsYerba Buena- toothache, pain, and arthritisSambong- renal calculiAmpalaya- diabetes mellitusNiyog-niyogan- anti-helminthicTsaang-Gubat- diarrheaAkapulko- fungal infection RA 8423: utilization of medicinal plants as alternative for high cost12/05/12 medications 97
  98. 98. D. Support mechanism made available TYPES OF PRIMARY HEALTH WORKERSVillage/Grassroots Intermediate Level Health Personnel ofHealth Workers First-Line HospitalsTrained Community General Medical Physicians withHealth worker; health Practitioners specialty areaauxiliary volunteer; Public Health Nurses NursesTraditional Birth Midwives DentistsAttendant Establish close contactInitial link, 1st contact of 1st source of with the village and12/05/12 community the professional healthcare intermediate level HW 98
  99. 99. Strategies and Programs:D – ental HealthO – perations for Environmental SanitationH – ealth Education and Community OrganizingP – revention and Control of Communicable DiseasesR – eproductive HealthO – lder Persons Health ServicesG – uidelines for NutritionR – ehabilitation and Management of Non-communicable Dse.A – lternative Health Care Practices (Herbal Meds/Acupressure)M – aternal and Child Health and IMCI12/05/12 99S – entrong Sigla Movement
  100. 100. Reproductive Health• Exercise of reproductive right & responsibility• Vision: RH practice as a way of life for every man and woman throughout life•Goals: 4 E’s > Every pregnancy should be intended > Every birth should be healthy > Every sex act should be free of coercion > Every family should achieve its desired size 12/05/12 100